Provider Demographics
NPI:1396535068
Name:GONZALEZ HENRIQUE, ANISLEIDIS
Entity type:Individual
Prefix:
First Name:ANISLEIDIS
Middle Name:
Last Name:GONZALEZ HENRIQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 49TH ST N APT 108
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-5766
Mailing Address - Country:US
Mailing Address - Phone:727-598-0280
Mailing Address - Fax:
Practice Address - Street 1:4201 49TH ST N APT 108
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-5766
Practice Address - Country:US
Practice Address - Phone:727-598-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25431739106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician